People with behavioral health needs are grossly overrepresented in the criminal legal system. Although jails and prisons have advanced protocols to screen for such needs, there has not been the same attention paid to individuals on probation, who comprise the largest segment of the criminal legal population. This paper discusses an initiative between a large urban probation department, a county health organization, and a research team. The initiative centers on the implementation of an evidence-based computer adaptive screening tool (CAT-MH) throughout the total probation population (over 18,000 individuals) to efficiently identify mental health and substance use treatment needs. The goal of the collaborative project is to screen clients for mental health symptoms and connect clients who screen positive to social worker at the county health organization, where referrals for community-based treatment can be made.
The role of the research team was to support the collaborative implementation of the program across systems and study the implementation process guided by the Interactive Systems Framework (ISF). The IFT articulates three systems/stages of implementation: Synthesis and Translation System; Support System; and Delivery System. As part of the project, the research team was given access to the probation site to attend CAT-MH implementation/planning meetings, train probation officers in the CAT-MH technology, observe the implementation process, and ensure that clients were connected county health social workers. The research team engaged in regular meetings with the probation and health systems leadership, as well as broader group of community stakeholders.
As part of the synthesis and translation system, the research team synthesized existing research on behavioral health screening tools, previous CAT-MH implementation findings. This research synthesis informed the collaborative planning process, which resulted in a plan to pilot the CAT-MH implementation during probation client intake. Additionally, training protocols were developed so that probation officers were informed of the screening instrument and their role in providing access to the screening. Moving to the support system, infrastructure and stabilization factors were identified, including the purchase of tablet devices, ensuring adequate wifi internet service, and drafting of initial implantation protocols. In the midst of the delivery system, or carrying out of the implementation protocol, probation operations were substantially affected by the COVID-19 pandemic, which effectively suspended in-person meetings with clients. This resulted in a re-engagement of the support system through problem-solving and planning, which resulted in a modified protocol to make the CAT-MH accessible to probationers via a system-generated text system. Core features of the delivery system are currently active, including ensuring capacity for large numbers of probationers who screen positive to have timely access to behavioral health service referrals through the county health system.
Conclusion and Implications
As guided by the ISF, the CAT-MH implementation process has identified numerous opportunities and challenges related to systematic behavioral health screening and referral in large probation systems. Capacity building across probation and health organizations is essential so that clients have enhanced opportunities to receive behavioral health services and avoid deeper involvement in the criminal legal system.